Brand Name: Pamelor
Generic Name: Nortriptyline

Nortriptyline

(nor-TRIP-ti-leen)

NEWLY DISCOVERED USES (OFF-LABEL)
Chronic fatigue syndrome, chronic nausea and vomiting, chronic neuropathic pain, diabetic neuropathy, migraine prevention, multiple sclerosis, panic disorder, post-herpetic neuralgia, premenstrual dysphoric disorder (PMDD), premenstrual syndrome (PMS), post-traumatic stress syndrome (PTSD), smoking cessation, stress incontinence, urge incontinence, vulvodynia

ORIGINAL USES (ON-LABEL)
Depression

BRAND NAME
Aventyl, Pamelor

DRUG CLASS
Antidepressant (tricyclic)

DESCRIPTION
Nortriptyline increases the levels of norepinephrine and serotonin in the body by inhibiting uptake of these chemicals by neurons.

POTENTIAL SIDE EFFECTS
Dry mouth, sedation, dizziness, headache, nervousness, skin rash, tremors, hives, nausea, constipation, vision changes, sweating, lowered blood pressure, increased heart rate, decreased sodium levels suicidal ideation, changes in heart rhythm and conduction, blurred vision, weight gain.

CAUTIONS

• Do not use if you have been taking an MAO inhibitor (such as phenelzine, tranylcypromine, isocarboxazid) within the past 14 days. When used with MAO-Is fever, high blood pressure, increased heart rate, confusion, seizures, and deaths have been reported
• Not for use immediately after a heart attack.
• Can cause sedation that may impair performance of tasks requiring alertness. Sedative effects may be additive with other drugs that cause similar effects (central nervous system depressants).
• May worsen psychosis or mania in patients with bipolar disease.
• Stop therapy with doctor permission and according to instructions (gradual taper) prior to elective surgery.
• Do not abruptly stop medication; taper gradually.
• Notify your doctor if you have low blood pressure as this drug can cause low blood pressure episodes.
• Use with caution in patients with urinary retention, history of cardiac disease, seizure disorders, diabetes, benign prostatic hyperplasia, narrow angle glaucoma, dry mouth, visual problems, constipation, or a history of bowel obstruction.
• Possibility of suicide attempt may persist until remission occurs.
• Use with caution in hyperthyroid patients or those receiving thyroid supplementation.
• Use with caution in patients with liver or kidney dysfunction and in elderly.

DRUG INTERACTIONS
MAO inhibitors (such as phenelzine, tranylcypromine, isocarboxazid), ritonavir, bupropion, amphetamines, anticholinergics, sedatives, chlorpropamide, tolazamide, warfarin, fluoxetine, fluvoxamine, citalopram, escitalopram, paroxetine, sertraline, cimetidine, carbamazepine, haloperidol, smoking, methylphenidate, valproic acid, clonidine, venlafaxine, protease inhibitors, quinidine, diltiazem, verapamil, lithium, phenothiazines may affect the levels of desipramine, drugs which prolong QT interval.

This drug is metabolized (inactivated) by a specific set of liver enzymes. Several other drugs interfere with these liver enzymes, and thus may increase or decrease the clearance of nortriptyline from the body, potentially increasing the risk of side effects or decreasing effectiveness. When these drugs are given in combination with nortriptyline, dosage adjustments may be needed. As these are too numerous to list, you should always check with your doctor or pharmacist prior to starting a new medication.

FOOD INTERACTIONS
Alcohol, grapefruit juice

HERBAL INTERACTIONS
Valerian, St. John’s wort, SAMe, kava kava

PREGNANCY AND BREAST-FEEDING CAUTIONS
FDA Pregnancy Risk Category D. Excreted in breast milk. Breast-feeding is not recommended during therapy with this drug.

SPECIAL INFORMATION
May take four to six weeks to for the full therapeutic effects to be experienced. Avoid prolonged exposure to sunlight, wear sunscreen.